When I told my father my plans he was clearly displeased. It was a spring day, and I was talking to him in his south suburban backyard. “Dad, I’m going to specialize in psychiatry.” His response was quick and sharp, “Why would you want to do that? You should become a real doctor. Psychiatrists aren’t doctors.”
By that point in my life, I had long charted my own course. I listened respectfully, but internally, I ignored his commands. I no longer needed his approval, and my conversation was more perfunctory rather than advice-seeking. He had his agenda, and I had mine. Since my decision would directly impact me, it was my decision to make. I subtly changed the topic to something that I knew would interest him. It was a deliberate manipulation on my part to a neutral subject, and the conversation moved forward.
His question was valid for other reasons. Why had I decided on this career path? My answer was both surprising yet understandable.
There are certain key events in my life that I write about repeatedly. They serve as markers that indicate significant changes in my knowledge of myself and the world around me. They are the road signs to my life. Many other factors are equally important, but these events note a change in understanding or direction. A fork in the road that led to a different journey.
I often talk about my dyslexia, a diagnosis that is only partially accurate. I use the term because it is relatable. In reality, I have a variety of processing differences that can make simple tasks difficult for me. For instance, I can visualize abstract concepts but can’t assemble a simple children’s jigsaw puzzle. This processing disparity was evident when I was in second grade and couldn’t read. In the early 1960s, the concept of learning disabilities was utterly foreign at the Catholic grade school that I attended. My teacher, a nun, recognized that I was smart and erroneously concluded that my inability was caused by a vision problem, which prompted my parents to get me a pair of glasses. This was a significant expense, and my father was not pleased, but he complied.
I was hoping for a miracle and was crushed to discover that they did little to translate the incomprehensible set of symbols that moved around the page with a mind of their own. I was at a phase in my life when I thought that any imperfection in me reflected poorly on my family and parents, and I was terrified of gaining even more displeasure from my father.
Yet, I had a certain confidence in myself, likely boosted by my teachers, who would comment on how smart I was. I had to devise a solution, and I felt confident I could. But what resources did I have? How could I take something I already had and use it as a tool? The answer came to me via the Sunday comics. There was a strip called “Nancy” that was very simple in both its storyline and vocabulary. I could piece together the words by tying them to the pictures. The traditional way I was being taught to read would never work for me because I could not see the separation between words and lines of text. However, if I viewed a word as a shape instead of a series of letters, I could decipher its meaning. My brain could do that, and print started to make sense. I did many other things to teach my brain how to read. Soon, an entire world of information was revealed to me. By the time I took my 4th-grade achievement tests, I was testing at the 11th-grade level.
I was a big kid, so I can’t say that I was the object of a lot of bullying. I was part of the mass group of kids; neither a member of the popular crowd nor the reject group. I had friends, and I did things. Yet, I felt like an imposter. Subjects that interested my friends didn’t particularly interest me, and things that I was interested in held no interest with them. I learned that to be accepted, I would have to show interest in what interested them while hiding those things that I was interested in.
My salvation was science, and my teachers were the pseudo-scientists of the B science fiction movies that I would watch on late-night TV. My ultimate hero and male role model was Don Herbert, AKA “Mr. Wizard” of TV fame. Mr. Wizard seemed to have the answer to how everything and anything worked. He showed me that there was a method to understanding, a way to prove ideas, and a methodology to learning. What he demonstrated formally was consistent with what I had been doing organically. Mr. Wizard didn’t know me, but he understood me. He had to, as what he was explaining on TV was exactly how I was already solving problems. Mr. Wizard allowed me to feel “normal.” I no longer believed I had to fake who I was; at least one person understood me.
My success in learning how to read taught me that authorities didn’t always know what was best and that there were solutions to seemingly impossible problems if I allowed myself to think outside the box. Mr. Wizard gave me a formal set of rules to test ideas. Science and math provided the tools to implement those solutions. I was suddenly empowered.
It was only natural that I would pursue science, and as I have said in a previous post, the most logical course of action would have been to obtain a Ph.D. and pursue a university career. I’m a rational person who examines potential outcomes, plots a course to achieve a particular goal, and then pursues that goal with force and dedication. It works… well, sort of… well, sometimes…well, hmmm..ummm…keep reading.
I have already told you how I successfully reached my goal of graduate school and even had the school pay for my education. A perfect plan? Then, despite all logic to the contrary, I had an irresistible urge to abandon my plan and apply to medical school, which was an insane idea that was bound to fail. I knew that I would never be accepted into medical school. All of my logic, all of my “scientific method,” and all of my dreams were tossed aside for a whim. Yet, that was precisely what I did; I allowed a force outside of myself to control my actions. I was as shocked as anyone when multiple medical schools accepted me. Many of them referred to how meaningful my personal statement was to them. Here was a kid who couldn’t read in second grade who was now moving doctors with his writing. Life is strange, isn’t it?
I have always had an immense interest in the interface between chemistry and biology. My graduate work centered on changes to proteins as they are extruded through a bacteria’s cell membrane. During my application to med school year, I left grad school and got a research job at the University of Chicago using tissue culture models to study Multiple Sclerosis. We were using a cutting-edge technology (this was in the 1970s) called monoclonal antibodies to create specific markers. Even then, I could see how such a targeted method could be utilized clinically, from cancer treatment to fighting infections. However, those advancements would be decades in the future.
Logic would dictate that I pursue an area of medicine that incorporated my scientific knowledge with clinical practice. The options were plenty: internal medicine sub-specialties like infectious diseases and endocrinology to specialties like Neurology. I knew that one of those areas would be a perfect fit. However, they weren’t.
I was so excited to do my internal medicine rotations, but they disappointed me. I spent 90% of my time running down labs, examining scans, and writing notes. The time that I spent with patients was minimal. It felt like I was back in the lab, but my subjects were humans this time. As a family practice doctor, I may have been happy as that medicine was more integrative. However, family practice options were discouraged at Northwestern. When I asked the medical school dean why, he responded, “Our mission is to produce specialists.” Despite this, my problem-solving and goal-direction abilities pointed me toward an internal medicine subspecialty. It was where my background and interests led me.
Psychiatry was never a consideration. I had some fears about the profession. My mother was frequently hospitalized for ketoacidosis, a condition caused by her out-of-control diabetes. Once, she was in a medical unit that shared a floor with Christ Hospital’s psych unit. That unit had an imposing locked metal door with a thin slit window made more solid with embedded mesh wire. It was scary looking, but young me was curious. I crept up to the door and, with all the courage I could muster, looked into the window, not knowing what to expect. From out of nowhere, a face appeared directly opposite me. A deranged and disheveled-looking man started to shout at me and threaten me. His face was one inch from mine, only separated by a thin piece of glass.
Along with his verbal threats, he started to beat on the door, and I could feel the vibrations inside my chest. I wanted to escape but felt frozen. My heart was racing, and I was overcome by fear. Eventually, I broke away and ran down the hall. In the background, I could hear laughing. At the time, it sounded like an insane laugh reminiscent of those heard in horror movies. In retrospect, I believe it was the laugh of someone who felt he had just played the greatest joke on an unsuspecting, nosey kid. However, it took me quite some time before I deciphered that realization. I was freaked out for years, and at one point, I even had a fear that I could accidentally be locked up in a psych unit, never to escape.
Our family has an intuitive psychological understanding, which stems from my mom. However, I never thought of pursuing psychology in any form. I was a science guy and never took a psychology course as an undergrad.
Medical students rotate through all of the specialties as part of their training, and at Northwestern, all M3s are required to do a 6-week general psych rotation. This rotation was a low priority for me, and my main concern was completing it as simply as possible. I wanted a site close to Northwestern’s downtown campus for convenience and picked the least desirable one because it was only a block away. I knew I would get it because no one else would want it. It was a drop-in center for the sickest psych patients, the most chronically ill. There, they could socially mingle, play a game, attend a group, get medically seen, and renew their prescriptions. Fellow students told horror stories about bizarre behavior and poor hygiene. No one wanted that rotation, so I picked it. I could survive anything for six weeks, and I wouldn’t have to travel to a distant site to complete my obligation.
My first day was as expected: bizarre, often disheveled individuals milling about, talking, and sometimes shouting to themselves. Mismatched clothes, sometimes garish makeup. “It is only six weeks out of my life,” I told myself. “I’ll do this one day at a time.” I had many obligations at that place, from doing initial psychiatric evaluations, to being a group therapy leader, to helping manage meds, to injecting patients with long-acting antipsychotics. However, I also had more free time than was typical for a clinical rotation. I started to hang around the day room. Sometimes, I would sit in the day room and read; at other times, I would play a game with a client. Eventually, something strange happened. Patients would come up to me and start a conversation. Those conversations were not about meds or the latest therapy; they were about their lives, hopes, and dreams. They would ask me about me, not in an intrusive way but in an interested way. I was becoming part of their group. They seemed to look forward to seeing me.
One day, a client could be rational, on the following day, completely psychotic. As they gained trust in me, they let me into their life, and I developed an admiration for them. Despite having constant hallucinations and delusions, many could still navigate the world, form relationships, and problem-solve. I would lack these abilities under such circumstances. Many lived a life of scorn and rejection, yet many of their desires were no different from mine. They wanted to connect with others, have value, and have those basic needs that we all require. In this crazy setting, I was doing what I wanted: helping someone improve their life, even if it was just a tiny bit. Knowing the biochemistry of psych meds helped, but just relating to them as human beings was just as important. I looked forward to showing up, playing a game of checkers, or talking to them about their past and present lives. I always felt different growing up, but kind individuals seemed to find me and convinced me that being different was OK.
Here, I was dealing with people who had problems very different from mine, people who were very different from me, yet all I could see was how similar we were underneath. These were human beings, not trash. They deserved to have the best life that they could. I felt called to spend time with them.
Once again, my logic, planning, and goal-setting were about to be tested. I had so much training in hard science, but much of Psychiatry was soft science. However, my course of action was right before me and couldn’t be ignored. Hard science told me that I could use powerful drugs to block dopamine receptors and reduce psychotic symptoms. However, soft science showed me that listening and relating to another human could be even more powerful. My beliefs were being challenged, but I was willing to listen. But was this experience a fluke? The only way to find out was to test the hypothesis, and I did that by picking psych electives that were completely different from my drop-in center experience. I did, and my mind did not change.
And so it started: residency, becoming chief resident, jobs, co-founding a clinic, working with the underserved, then… then…then.
Do you ever think there is some guiding force beyond yourself that directs you if you allow that direction? A guardian angle? God’s direct interest in you? Some other force. Despite all of my planning, logic, and science, my best decisions in life seem to come from outside of me. Interesting, no?
